| NPI | 1558470443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: FL ME74194) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: FL ME74194) |
| 207Q00000X Family Medicine (Licence: FL me-74194) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2023-03-29 |