| NPI | 1003922279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD00029275) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA MD17675) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2022-02-04 |