| NPI | 1003818147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: SD 0546) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: SD 0546) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2023-04-05 |