| NPI | 1407941396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601004356) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 5601004356) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2023-03-02 |