NPI | 1770524977 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208800000X Urology (Licence: WV 2253) |
Additional Taxonomies | 208D00000X General Practice (Licence: WV 2253) |
363A00000X Physician Assistant | |
Enumeration Date | 2006-06-09 |
Last Update Date | 2012-04-24 |