| NPI | 1538257589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR MD19132) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA MD000323633) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2008-03-12 |