| NPI | 1396150140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME147159) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL trn20137) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA ML60569414) | |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2021-03-24 |