| NPI | 1760481840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME105196) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MD DO2545) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2010-03-11 |