| NPI | 1396734851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: FL ME00029315) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME29315) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2022-07-21 |