| NPI | 1497954937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR PA00628) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA00628) |
| Enumeration Date | 2007-07-14 |
| Last Update Date | 2010-08-05 |