| NPI | 1326038886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD424017) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME 92201) |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2012-08-29 |