| NPI | 1578673372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: WA ML20007900) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA ML20007900) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2022-10-07 |