| NPI | 1164401311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME111184) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WI 45013-020) |
| Enumeration Date | 2006-01-14 |
| Last Update Date | 2015-06-03 |