| NPI | 1558435768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME107439) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MD D37292) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2015-01-29 |