| NPI | 1487809190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IA 38780) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME102545) |
| Enumeration Date | 2008-11-21 |
| Last Update Date | 2020-10-14 |