| NPI | 1801418611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME151981) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN30881) |
| Enumeration Date | 2020-05-14 |
| Last Update Date | 2026-07-23 |