| NPI | 1528696200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA 20A22628) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX V0226) |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2025-08-21 |