| NPI | 1538546957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 62905) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA 145153) |
| 207N00000X Dermatology (Licence: NH 20079) | |
| Enumeration Date | 2015-05-05 |
| Last Update Date | 2022-01-13 |