| NPI | 1346304540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME96509) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: FL ME96509) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: FL ME96509) | |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2019-09-12 |