| NPI | 1770015422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME164871) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208800000X Urology (Licence: LA 1770015422) | |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2023-10-20 |