| NPI | 1881057594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: ME DO2935) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL uo4767) |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2020-04-01 |