| NPI | 1174942403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA 19114) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL OS13861) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2026-08-05 |