| NPI | 1952379513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MD D74851) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A79355) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2019-03-13 |