| NPI | 1396791133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP 1554842) |
| Additional Taxonomies | 208800000X Urology (Licence: FL 1554842) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2014-10-22 |