| NPI | 1427462167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X Urology, Pediatric Urology (Licence: FL ME144710) |
| Additional Taxonomies | 208800000X Urology (Licence: FL ME144710) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2022-05-04 |