| NPI | 1568570778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NH 11465) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME 29329) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2021-04-08 |