| NPI | 1073637708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0024079837) |
| Additional Taxonomies | 208800000X Urology (Licence: VA 0024079837) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2019-03-08 |