| NPI | 1598183659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: MA 273925) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: FL ME140017) |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2019-08-12 |