| NPI | 1912227471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: VA 0101258323) |
| Additional Taxonomies | 208800000X Urology (Licence: ME MD28577) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116022424) | |
| Enumeration Date | 2010-06-08 |
| Last Update Date | 2025-01-27 |