NPI | 1467426387 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: SD 0361) |
Additional Taxonomies | 207N00000X Dermatology (Licence: SD 0361) |
Enumeration Date | 2006-02-15 |
Last Update Date | 2018-03-02 |