| NPI | 1811316243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD60845409) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OR MD186347) |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2024-11-13 |