| NPI | 1083653653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR MD126216) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA MD00039772) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2020-10-05 |