| NPI | 1699818120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR MD26968) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA MD00047161) |
| 207N00000X Dermatology (Licence: MO 2003010752) | |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2021-03-22 |