| NPI | 1629169396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA PA11313) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA 11313) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2008-05-07 |