| NPI | 1912931635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD00039710) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: WA MD0039710) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2008-03-24 |