| NPI | 1811965627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD00030747) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00030747) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2008-01-08 |