| NPI | 1336194547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: ME MD25087) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 166204) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2025-03-17 |