| NPI | 1942892369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001011006) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 001011006) |
| Enumeration Date | 2021-02-08 |
| Last Update Date | 2021-04-21 |