| NPI | 1073135935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171400000X Health & Wellness Coach |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ MD-GTL-20-00148) |
| 208800000X Urology (Licence: NJ MD-GTL-20-00148) | |
| Enumeration Date | 2020-05-14 |
| Last Update Date | 2024-04-26 |