| NPI | 1487834693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME 100658) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: FL ME100658) |
| 207NS0135X Dermatology Procedural Dermatology (Licence: FL ME100658) | |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2021-01-05 |