| NPI | 1891729109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA G58431) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: UT 1862071205) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2019-01-14 |