| NPI | 1700980307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME0050087) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME0050087) |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2023-06-27 |