| NPI | 1013998772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME0066724) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AL 18488) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2012-04-19 |