| NPI | 1124647557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NY 325636) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 325636) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-15 |
| Last Update Date | 2026-04-08 |