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 |