| NPI | 1528154713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD00009476) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD00009476) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2021-03-23 |