| NPI | 1427218270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD61130459) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NE 25621) |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2021-11-22 |