| NPI | 1508443532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR DO224180) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA OP61676706) |
| Enumeration Date | 2021-03-25 |
| Last Update Date | 2025-09-24 |