| NPI | 1235124967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME78907) |
| Additional Taxonomies | 207ND0900X Dermatology Dermatopathology (Licence: FL ME78907) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2022-07-11 |