| NPI | 1457354136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR MD151399) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A 86773) |
| 207N00000X Dermatology (Licence: WA MD60085709) | |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2016-06-09 |