| NPI | 1346297108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A77413) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA MD70031714) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2025-12-13 |