| NPI | 1538719844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 95012743) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA 95012743) |
| Enumeration Date | 2019-09-18 |
| Last Update Date | 2025-11-05 |