| NPI | 1336255793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 13111) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA G-34444) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2021-03-15 |