| NPI | 1265667505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: AZ 52763) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN15483) | |
| 208800000X Urology (Licence: MI 4301099607) | |
| Enumeration Date | 2009-05-15 |
| Last Update Date | 2016-07-22 |