| NPI | 1801058821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MS 20677) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN#12298) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2011-10-24 |