| NPI | 1336599232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2022-00012) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA 168537) |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2022-08-03 |