| NPI | 1164442562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: GA 052722) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 004533) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2014-04-16 |