| NPI | 1780043703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA 22080) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS15102) |
| Enumeration Date | 2016-02-18 |
| Last Update Date | 2024-01-03 |