| NPI | 1922029271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A79025) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA MD00046746) |
| 207N00000X Dermatology (Licence: HI MD-13554) | |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2020-08-26 |