| NPI | 1033217542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX C8419) |
| Additional Taxonomies | 208800000X Urology (Licence: TX C8419) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2016-03-14 |