NPI | 1043988447 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA204341) |
Additional Taxonomies | 208800000X Urology (Licence: OR 204341) |
Enumeration Date | 2021-08-31 |
Last Update Date | 2025-08-20 |