| NPI | 1396741351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA G50454) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NV 20979) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2025-04-01 |