| NPI | 1912983396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MN 36257) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AZ 25938) |
| 207N00000X Dermatology (Licence: FL ME63277) | |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2020-08-13 |