| NPI | 1144512641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X (Licence: VA 0101260899) |
| Additional Taxonomies | 208800000X Urology (Licence: FL ME135284) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: DC MD044515) | |
| Enumeration Date | 2011-05-03 |
| Last Update Date | 2023-05-04 |