| NPI | 1316441066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NH 22327) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: ME MD26935) |
| 207N00000X Dermatology (Licence: NY 318928) | |
| 207N00000X Dermatology (Licence: PA MD479452) | |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2024-10-08 |