| NPI | 1588601702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA G63889) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NV 7114) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2008-01-17 |