| NPI | 1730507617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO 2020010839) |
| Additional Taxonomies | 174400000X Specialist |
| 207N00000X Dermatology (Licence: CA A152049) | |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2021-03-17 |