| NPI | 1609098136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 231481) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A113539) |
| 207N00000X Dermatology (Licence: NC 200500216) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2021-03-22 |