| NPI | 1356874218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A157977) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: UT 10979090-1205) |
| Enumeration Date | 2017-04-07 |
| Last Update Date | 2023-10-27 |