| NPI | 1740363902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME102502) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 94-00069) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2016-04-08 |