| NPI | 1649739541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MD D0102480) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208800000X Urology (Licence: NJ 25MA12135100) | |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2025-09-04 |