| NPI | 1760877633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA C183093) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA 1760877633) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2023-03-09 |