| NPI | 1760045355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NM MD2023-1076) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A186212) |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2023-09-01 |