| NPI | 1538242318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: ID MD8169) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA MD00012692) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2007-07-09 |