| NPI | 1881681690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: FL ME0044811) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: FL 10D0686545) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2007-08-30 |