| NPI | 1891905980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO 053327) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A 112829) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2021-06-15 |