| NPI | 1134150501 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C173348) | 
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: FL ME75221) | 
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: FL ME75221) | |
| Enumeration Date | 2006-07-05 | 
| Last Update Date | 2025-08-25 |