| NPI | 1760607808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 238470) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: RI LP00867) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2022-04-21 |