| NPI | 1396893046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA G49571) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G49571) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2026-08-25 |