| NPI | 1982675690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR MD174125) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA 60595972) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2023-12-17 |