| NPI | 1265099097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A184360) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA F590) |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2024-10-02 |