| NPI | 1578736724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA 20A12076) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WI 51343021) |
| 207N00000X Dermatology (Licence: NV DO1741) | |
| Enumeration Date | 2008-04-09 |
| Last Update Date | 2023-03-07 |