| NPI | 1700871415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME0026490) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: FL ME0026490) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: FL ME0026490) | |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2013-06-18 |