| NPI | 1497478911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: GA 11063) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 11063) |
| Enumeration Date | 2022-09-20 |
| Last Update Date | 2024-02-21 |