| NPI | 1538639497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: GA RN252065) |
| Additional Taxonomies | 208800000X Urology (Licence: GA RN252065) |
| 363LF0000X Nurse Practitioner Family (Licence: AZ 288860) | |
| Enumeration Date | 2018-12-04 |
| Last Update Date | 2023-04-01 |