| NPI | 1740455682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME148317) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A128147) |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2024-09-09 |