| NPI | 1659342558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: ME MD18763) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0101233289) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2016-06-06 |