| NPI | 1699200717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA G29375) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: CA G29375) |
| 207Q00000X Family Medicine (Licence: CA G29375) | |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2017-04-26 |