| NPI | 1629673355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-12468) |
| Additional Taxonomies | 208800000X Urology (Licence: NC 0010-12468) |
| 363A00000X Physician Assistant (Licence: NC 0010-12468) | |
| Enumeration Date | 2020-12-01 |
| Last Update Date | 2023-06-16 |