| NPI | 1891737201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR MD181659) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A84048) |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2021-03-18 |