| NPI | 1134705148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A193963) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AR E-18546) |
| Enumeration Date | 2021-03-20 |
| Last Update Date | 2025-06-27 |