| NPI | 1962745133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X (Licence: NY 302506) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MD467016) |
| 2088P0231X (Licence: PA MD467016) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT215493) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-05 |
| Last Update Date | 2020-07-20 |