| NPI | 1275573867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME164038) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: RI MD10937) |
| 207N00000X Dermatology (Licence: NC 2006-01915) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2023-11-01 |