| NPI | 1548240039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 56678) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NH 14501) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2026-04-24 |