| NPI | 1174818710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME134811) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 247721) |
| Enumeration Date | 2011-06-11 |
| Last Update Date | 2022-10-03 |