| NPI | 1043666365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: GA 92361) |
| Additional Taxonomies | 208800000X Urology (Licence: FL ME150656) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2023-05-12 |