| NPI | 1306291802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OR PA181919) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: OR PA181919) |
| Enumeration Date | 2016-05-03 |
| Last Update Date | 2019-07-23 |