| NPI | 1982036141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD60848120) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA MD60848120) |
| Enumeration Date | 2013-07-30 |
| Last Update Date | 2025-05-25 |