| NPI | 1255398244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD60713547) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TN 55008) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2021-05-10 |