| NPI | 1376882464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA OS021845) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 300565) |
| 363A00000X Physician Assistant (Licence: NY 016380) | |
| Enumeration Date | 2013-02-08 |
| Last Update Date | 2022-09-07 |