| NPI | 1780115261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A159922) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: UT 12441612-1205) |
| Enumeration Date | 2017-03-25 |
| Last Update Date | 2025-04-09 |