| NPI | 1730207523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD00038749) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OR MD18223) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2023-07-24 |