| NPI | 1306046180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME MD19164) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX N7441) |
| 207Q00000X Family Medicine (Licence: TX N7441) | |
| 207N00000X Dermatology (Licence: ME MD19164) | |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2019-05-31 |