| NPI | 1013366582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME133728) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA MD.MD.61643734) |
| 207N00000X Dermatology (Licence: MA 293390) | |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2025-09-19 |