| NPI | 1982738779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD00017587) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00017587) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2012-01-05 |