| NPI | 1235524018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME155049) |
| Additional Taxonomies | 208800000X Urology (Licence: WI 72970) |
| 208800000X Urology (Licence: KS 9408678) | |
| 208800000X Urology (Licence: MN 67103) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2022-05-17 |