| NPI | 1225473416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA 60898358) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WI 67721-20) |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2021-05-10 |