| NPI | 1922024033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD00037526) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NH 25285) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2024-03-18 |