| NPI | 1417937541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA G74608) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G74608) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2025-09-11 |