| NPI | 1528085040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601003430) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 5601003430) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2022-04-11 |