| NPI | 1992221980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 10476224-1206) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: UT 10476224-1206) |
| Enumeration Date | 2017-08-21 |
| Last Update Date | 2021-06-14 |