| NPI | 1508955287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD00028449) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: WA MD00028449) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2007-07-20 |