| NPI | 1568696789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA C161936) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX P2626) |
| Enumeration Date | 2009-05-04 |
| Last Update Date | 2019-09-06 |