| NPI | 1215372032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A132102) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA MT132102) |
| 207R00000X Internal Medicine (Licence: PA MT203617) | |
| Enumeration Date | 2013-05-07 |
| Last Update Date | 2018-10-29 |