| NPI | 1184813123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME114921) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN11143) |
| Enumeration Date | 2007-10-16 |
| Last Update Date | 2021-07-06 |