| NPI | 1740677079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD61283001) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 57008) |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2024-09-27 |