| NPI | 1588442388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: LA 338909) |
| Additional Taxonomies | 208800000X Urology (Licence: LA 338909) |
| Enumeration Date | 2023-09-21 |
| Last Update Date | 2025-06-09 |