| NPI | 1417469982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ AP10605) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP10605) |
| Enumeration Date | 2017-10-24 |
| Last Update Date | 2024-04-12 |