| NPI | 1902148315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD60996093) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60996093) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: GA 42957) | |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: CA GFE60673) | |
| Enumeration Date | 2013-03-24 |
| Last Update Date | 2020-04-08 |