| NPI | 1477865194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 5131797-1204) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA OP60440339) |
| Enumeration Date | 2010-07-10 |
| Last Update Date | 2021-11-02 |