| NPI | 1578522199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY 1065386) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KY 1065386) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2007-11-28 |