| NPI | 1265545974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME13631) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME13631) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2007-07-08 |