| NPI | 1548368749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 42759) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A30049) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2019-06-14 |