| NPI | 1740472380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME 119126) |
| Additional Taxonomies | 207NP0225X Dermatology, Pediatric Dermatology (Licence: FL ME119126) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: FL ME119126) | |
| Enumeration Date | 2007-08-17 |
| Last Update Date | 2015-10-16 |