| NPI | 1720272644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME63627) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: FL ME63627) |
| 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: FL ME63627) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: FL ME63627) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: FL ME63627) | |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2012-12-11 |