| NPI | 1720048002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MS PA013) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MS PA00013) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2017-11-20 |