| NPI | 1790196699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME135477) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 59759) |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2021-12-15 |