| NPI | 1285742007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME88229) |
| Additional Taxonomies | 207NP0225X Dermatology, Pediatric Dermatology (Licence: FL ME88229) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2008-04-07 |