| NPI | 1699877183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD00035764) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OR MD18927) |
| Enumeration Date | 2006-09-04 |
| Last Update Date | 2007-07-12 |