| NPI | 1396230116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 7283004-1206) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: UT 7283004-1206) |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2020-09-23 |