| NPI | 1548200785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M8385) |
| Additional Taxonomies | 208800000X Urology (Licence: MO R5H02) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2021-05-13 |