| NPI | 1992902662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0102206282) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2024-07-16 |