| NPI | 1609091289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 5032) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: GA 005032) |
| 207NS0135X Dermatology Procedural Dermatology (Licence: GA 005032) | |
| 207NP0225X Dermatology Pediatric Dermatology (Licence: GA 005032) | |
| 363A00000X Physician Assistant (Licence: GA 005032) | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2013-10-24 |