| NPI | 1700156064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NV 15717) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A123991) |
| Enumeration Date | 2012-01-04 |
| Last Update Date | 2015-07-30 |