| NPI | 1871773036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD453364) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A105214) |
| Enumeration Date | 2007-11-05 |
| Last Update Date | 2015-02-02 |