| NPI | 1619555281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA15586) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX 39020000X) |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2023-05-22 |