| NPI | 1952357188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA G63544) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NV 7006) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2018-06-28 |