| NPI | 1366079956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A187745) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A187745) |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2024-07-17 |