| NPI | 1720189657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME112983) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MD D33428) |
| 207ND0900X Dermatology, Dermatopathology (Licence: MD D33428) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: FL ME112983) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2016-09-07 |