| NPI | 1043453970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME106806) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: FL ME106806) |
| Enumeration Date | 2009-04-08 |
| Last Update Date | 2025-09-23 |