| NPI | 1316904055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NV 3293) |
| Additional Taxonomies | 163WU0100X Registered Nurse, Urology (Licence: NV 3293) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2009-07-07 |