| NPI | 1801978457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A66131) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A66131) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2021-03-23 |