| NPI | 1427668250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110009727) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AR PA-1175) |
| Enumeration Date | 2020-08-06 |
| Last Update Date | 2024-03-27 |