| NPI | 1689134348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA 4053) |
| Additional Taxonomies | 207NP0225X Dermatology, Pediatric Dermatology (Licence: CA A182042) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2025-11-18 |