| NPI | 1790826394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA C163030) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MD448189) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2022-06-07 |