| NPI | 1063448009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN124279) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: GA RN124279) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2021-03-31 |