| NPI | 1861757320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A14183) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL UO3035) |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2022-08-11 |