| NPI | 1376651026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: GA rn105862) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: SC APN2728) |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: SC APN2728) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: GA rn105862) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: SC APN2728) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: GA rn105862) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: GA RN105862) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: SC APN2728) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2021-03-31 |