| NPI | 1942412291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A83358) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A83358) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2021-03-30 |