| NPI | 1114153459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD60359915) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301094116) |
| Enumeration Date | 2009-06-01 |
| Last Update Date | 2015-07-07 |