| NPI | 1063779429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MA10617900) |
| Additional Taxonomies | 2088P0231X Urology, Pediatric Urology (Licence: NJ 25MA10617900) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2023-05-08 |