| NPI | 1255417036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NP0225X Dermatology, Pediatric Dermatology (Licence: WA MD00015240) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA MD00015240) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2009-03-03 |