| NPI | 1942616750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: SC 2119) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 2119) |
| 363AS0400X Physician Assistant, Surgical (Licence: SC 2119) | |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2023-12-12 |