| NPI | 1619495579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A190261) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A190261) |
| Enumeration Date | 2017-08-31 |
| Last Update Date | 2026-09-01 |