| NPI | 1366519621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD60270947) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: GA 025046) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2012-06-13 |