| NPI | 1942614979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: ME MD23704) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 259031) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2020-07-08 |