| NPI | 1619177045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: FL ME18483) |
| Additional Taxonomies | 208800000X Urology (Licence: FL ME18483) |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2007-07-24 |