| NPI | 1982764502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WU0100X Registered Nurse, Urology (Licence: VA 0101032497) |
| Additional Taxonomies | 163WU0100X Registered Nurse, Urology (Licence: MD D22142) |
| 163WU0100X Registered Nurse, Urology (Licence: DC MD31255) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2007-07-08 |