| NPI | 1790846095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA G203155) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME 83086) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2025-10-03 |