| NPI | 1275915316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TN 63663) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A146884) |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2022-03-29 |