| NPI | 1780734582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A91946) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A91946) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2022-01-03 |