| NPI | 1568464931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME0064670) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME0064670) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2020-09-18 |