| NPI | 1205351459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 54705) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA 54705) |
| Enumeration Date | 2017-08-09 |
| Last Update Date | 2017-08-09 |