| NPI | 1750447504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD00026961) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00026961) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2007-07-08 |