| NPI | 1184068520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NY 298949) |
| Additional Taxonomies | 208800000X Urology (Licence: RI MD16713) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-27 |
| Last Update Date | 2022-04-10 |