| NPI | 1255349288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA G84556) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WI 35535-20) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2014-04-21 |