| NPI | 1417070566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA 20A12033) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A12033) |
| 207Q00000X Family Medicine (Licence: TX N4544) | |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2021-04-12 |