| NPI | 1568560688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MN 63613) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G68293) |
| 207N00000X Dermatology (Licence: FL ME100082) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2018-04-26 |