| 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 |