| NPI | 1861911570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 54839) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: CA 1841216082) |
| Enumeration Date | 2017-09-13 |
| Last Update Date | 2017-12-19 |