| NPI | 1306360474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME169743) |
| Additional Taxonomies | 208800000X Urology (Licence: NY 322498) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 25744) | |
| Enumeration Date | 2017-08-01 |
| Last Update Date | 2024-11-25 |