| NPI | 1154559375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD452484) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A126572) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2020-08-27 |