| NPI | 1740624915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: LA 335013) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: GA 88329) |
| 207N00000X Dermatology (Licence: CA A148600) | |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2023-05-06 |