| NPI | 1568442093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NH 24800) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 224097) |
| 207N00000X Dermatology (Licence: NY 227732-1) | |
| 207N00000X Dermatology (Licence: ME 016935) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2023-10-18 |