| NPI | 1376174235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX AP144712) |
| Additional Taxonomies | 208800000X Urology (Licence: TX 861730) |
| Enumeration Date | 2020-01-30 |
| Last Update Date | 2024-07-09 |