| NPI | 1205815859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: FL ME108867) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35064102) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: FL ME108867) | |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2022-05-24 |