| NPI | 1174614663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME0024691) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: FL ME0024691) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2007-07-08 |