| NPI | 1528149366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME 91215) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 197570-1) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2012-09-07 |