| NPI | 1699720763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: FL PA9101548) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL PA9101548) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2022-08-22 |