| NPI | 1669988846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A196438) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME168462) |
| Enumeration Date | 2017-12-24 |
| Last Update Date | 2026-01-21 |