| NPI | 1508250432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD61111284) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: UT 10118459-1205) |
| Enumeration Date | 2015-03-28 |
| Last Update Date | 2020-12-31 |