| NPI | 1609138718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD.60631007) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 252206) |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2022-07-21 |