| NPI | 1649543463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA1317) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NV PA1317) |
| Enumeration Date | 2012-02-10 |
| Last Update Date | 2018-03-17 |