| NPI | 1720341555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 53066) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NV PA1460) |
| 363A00000X Physician Assistant (Licence: NV PA1460) | |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2019-08-30 |