| NPI | 1427043595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AR N6504) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA G49022) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2018-03-14 |