| NPI | 1790793685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA PA10004684) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OR PA10004684) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2024-01-24 |