| NPI | 1144687708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-06230) |
| Additional Taxonomies | 208800000X Urology (Licence: NC 0010-06230) |
| Enumeration Date | 2016-01-26 |
| Last Update Date | 2022-03-21 |