| NPI | 1073571295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA C148028) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: UT 52631431205) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2023-01-19 |