| NPI | 1306828843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME143868) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 55708) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2024-01-11 |