| NPI | 1487614293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME62586) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL me62586) |
| 207ND0900X Dermatology, Dermatopathology (Licence: FL ME62586) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2015-10-07 |