| NPI | 1548420342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD60613340) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IA R-9627) |
| 208D00000X General Practice (Licence: VA 0101246102) | |
| Enumeration Date | 2008-06-15 |
| Last Update Date | 2022-07-21 |