| NPI | 1063858595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MA11161900) |
| Additional Taxonomies | 208800000X Urology (Licence: MD D86943) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-10 |
| Last Update Date | 2021-09-27 |