| NPI | 1366823775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME136133) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: FL ME136133) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: FL ME136133) | |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2022-12-13 |