| NPI | 1386969608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A130130) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: CA A130130) |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2026-05-26 |