| NPI | 1912310442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: ME DO3032) |
| Additional Taxonomies | 208800000X Urology (Licence: SC 82201) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT015640) | |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2020-08-02 |