| NPI | 1942620869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A153840) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MO 2015014060) |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2022-09-06 |