| NPI | 1669415188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA377) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: ID M7247) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2014-12-05 |