| NPI | 1437914538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA 95029094) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95029094) |
| Enumeration Date | 2024-02-19 |
| Last Update Date | 2024-08-28 |