| NPI | 1801377072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9365856) |
| Additional Taxonomies | 208800000X Urology (Licence: FL APRN9365856) |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2026-02-23 |