| NPI | 1881990737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A84002) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A84002) |
| 207ND0900X Dermatology, Dermatopathology (Licence: CA A84002) | |
| 207Q00000X Family Medicine (Licence: CA A84002) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: CA A84002) | |
| Enumeration Date | 2011-02-09 |
| Last Update Date | 2025-01-10 |