| NPI | 1407953086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MT 5160) |
| Additional Taxonomies | 208800000X Urology (Licence: MT 5160) |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2014-12-09 |