| NPI | 1588643613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 200501773) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA MD 60313749) |
| 207N00000X Dermatology (Licence: WA MD60313749) | |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2022-02-16 |