| NPI | 1396724779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MD D43966) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME124714) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2018-11-16 |