| NPI | 1194192872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MT220424) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT220424) |
| 363A00000X Physician Assistant (Licence: MD C0005826) | |
| Enumeration Date | 2015-08-28 |
| Last Update Date | 2023-01-09 |