| NPI | 1639278260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD00010736) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: WA MD00010736) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2007-07-08 |