| 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 |