| NPI | 1467209940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA GAA-NP002253) |
| Additional Taxonomies | 208800000X Urology (Licence: GA GAA-NP002253) |
| Enumeration Date | 2024-05-02 |
| Last Update Date | 2024-07-23 |