| NPI | 1578536736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: CA A97517) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IN 01053757A) |
| 207NS0135X Dermatology Procedural Dermatology (Licence: CA A97517) | |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2024-03-04 |