| NPI | 1720140643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: SC PA3809) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 007910) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2024-04-05 |