| NPI | 1982629598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 100155) |
| Additional Taxonomies | 208800000X Urology (Licence: NC 100155) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2016-12-06 |