| NPI | 1922600519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 24357) |
| Additional Taxonomies | 208800000X Urology (Licence: SC 24357) |
| Enumeration Date | 2020-11-10 |
| Last Update Date | 2021-02-25 |