| NPI | 1194704478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD00027322) |
| Additional Taxonomies | 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: WA MD00027322) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2007-08-07 |