| NPI | 1336352087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR MD24539) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA MD00042633) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2022-02-04 |