| NPI | 1619388535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MA10390900) |
| Additional Taxonomies | 208800000X Urology (Licence: GA 006805) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2025-12-03 |