| NPI | 1184824237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR MD223071) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA MD00042937) |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2025-02-26 |