| NPI | 1508838061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME105156) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MD025703E) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2025-12-08 |