| NPI | 1366414591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA C53682) |
| Additional Taxonomies | 207NP0225X Dermatology, Pediatric Dermatology (Licence: CA C53682) |
| 208000000X Pediatrics (Licence: CA C53682) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2018-04-06 |