| NPI | 1093594004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL 11028872) |
| Additional Taxonomies | 208800000X Urology (Licence: FL 11028872) |
| Enumeration Date | 2023-09-28 |
| Last Update Date | 2025-10-01 |