| NPI | 1285634550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME26767) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: FL ME26767) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2016-01-28 |