| NPI | 1285891150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A111235) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NM MD2012-0453) |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2024-04-08 |