| NPI | 1386933570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: FL PA9105662) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9105662) |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2021-10-29 |