| NPI | 1801206180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA in process) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A142730) |
| Enumeration Date | 2014-05-07 |
| Last Update Date | 2022-01-14 |