| NPI | 1780002881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: UT 5554051-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 281818) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2021-11-17 |