| NPI | 1669145249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: SC 3837) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 3837) |
| Enumeration Date | 2021-07-29 |
| Last Update Date | 2024-05-08 |