| NPI | 1437287315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA13497) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA 13497) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2018-03-17 |