| NPI | 1467912550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD61450806) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MO 2020016711) |
| Enumeration Date | 2019-03-23 |
| Last Update Date | 2024-02-05 |