| NPI | 1598261463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX T9054) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA 177564) |
| Enumeration Date | 2018-04-01 |
| Last Update Date | 2024-07-08 |