| NPI | 1366975658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 12173288-1205) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME137397) |
| 207R00000X Internal Medicine (Licence: FL TRN24708) | |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2026-08-21 |