| NPI | 1255722617 |
|---|---|
| Other Name | BRANDON NICKLE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 10260137-1204) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL uo3507) |
| Enumeration Date | 2015-02-06 |
| Last Update Date | 2022-07-21 |