| NPI | 1780210443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME180526) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: RI LP05246) |
| Enumeration Date | 2020-03-13 |
| Last Update Date | 2026-06-30 |