| NPI | 1790912251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A120641) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA L-239279) |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2024-04-16 |