| NPI | 1881766186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A49251) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NV 7871) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2019-08-07 |