| NPI | 1871577700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO DR.0065413) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME93317) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2026-08-06 |