| NPI | 1205222171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 4301108257) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME136777) |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2024-09-18 |