| NPI | 1124120902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA16231) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA PA16231) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2020-11-02 |