| NPI | 1659423358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9103060) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL PA9103060) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2021-03-16 |