| NPI | 1083439020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NC 15249) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 15249) |
| Enumeration Date | 2024-11-15 |
| Last Update Date | 2025-04-18 |