| NPI | 1235427584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD.MD61203106) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: WA MD.MD61203106) |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2021-08-06 |