NPI | 1508291717 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NE 1768) |
Additional Taxonomies | 207N00000X Dermatology (Licence: NE 1768) |
363AM0700X Physician Assistant, Medical (Licence: IA 002439) | |
Enumeration Date | 2013-09-06 |
Last Update Date | 2022-07-21 |