| NPI | 1205081577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME121387) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX N8428) |
| 207ND0900X Dermatology, Dermatopathology (Licence: FL ME121387) | |
| Enumeration Date | 2008-11-29 |
| Last Update Date | 2016-11-04 |