| NPI | 1205890035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: ME DO3222) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: DE C2-0009898) |
| 207N00000X Dermatology (Licence: NY 202324) | |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2024-01-31 |