| NPI | 1407804644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME 101848) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 227581) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2021-03-30 |