| NPI | 1245262419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OK 1311) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OK APA1311) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2016-08-19 |