| NPI | 1316920747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME 73845) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: FL ME 73845) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: FL ME 73845) | |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2014-07-21 |