| NPI | 1669462123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME92940) |
| Additional Taxonomies | 2471S1302X Radiologic Technologist, Sonography (Licence: FL ME92940) |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2024-04-25 |