| NPI | 1841282340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: FL 0021279) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: FL ME0021279) |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2007-12-07 |