| NPI | 1154584084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME133190) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MD443020) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2020-07-08 |