| NPI | 1457379000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA G50681) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: CA G50681) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CA G50681) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2023-03-07 |