| NPI | 1720247992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: FL ME37757) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: FL ME37757) |
| 208600000X Surgery (Licence: FL ME037757) | |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2015-06-26 |