| NPI | 1497103105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A150395) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 94134) |
| 207N00000X Dermatology (Licence: MD D87162) | |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2025-12-16 |