| NPI | 1871579649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME0117213) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 200000825) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2020-02-04 |