| NPI | 1659352219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA 20A8900) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CA 20a8900) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2023-05-01 |