| NPI | 1073968947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA 20A22410) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0102204954) |
| 208D00000X General Practice (Licence: VA 0102204954) | |
| Enumeration Date | 2016-04-28 |
| Last Update Date | 2025-08-21 |