| NPI | 1639174220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2007-00385) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME 11708) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2009-03-19 |