| NPI | 1568842185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NP0225X Dermatology, Pediatric Dermatology (Licence: WA OP61156882) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA R-10324) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2022-12-01 |