| NPI | 1649272832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA C42190) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA C042190) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2024-03-13 |