| NPI | 1639403462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME116210) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MT194482) |
| Enumeration Date | 2009-09-27 |
| Last Update Date | 2015-06-26 |