| NPI | 1053308239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA 20A6512) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 192431) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2020-12-04 |