| NPI | 1912904772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI ES009557) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA 20A19529) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2024-01-31 |