| NPI | 1891862082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OK 1214) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MO 2004030997) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2014-09-11 |