| NPI | 1134110091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA C50794) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 121173) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2018-07-13 |