| NPI | 1245320308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PR 18888) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME100407) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2019-08-21 |