| NPI | 1902433634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A202551) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301509798) |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2026-07-23 |