| NPI | 1063855138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME153611) |
| Additional Taxonomies | 208800000X Urology (Licence: AL MD.33650) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-09 |
| Last Update Date | 2022-01-06 |