| NPI | 1083694509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: ME 018037) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 48025) |
| 207N00000X Dermatology (Licence: AZ 37487) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2009-07-31 |