| NPI | 1568604668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME118731) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 35.122891) |
| Enumeration Date | 2009-04-03 |
| Last Update Date | 2014-06-30 |