| NPI | 1831414143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME110963) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN#14540) |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2017-03-31 |