| NPI | 1003084591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD61392866) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 269584-1) |
| Enumeration Date | 2008-02-18 |
| Last Update Date | 2023-08-31 |