| NPI | 1497826424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD00021424) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA G40174) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2010-10-04 |