| NPI | 1013945724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME100776) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: FL MFC1468) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2013-02-07 |