| NPI | 1922146596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME142177) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CO 0061102) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: IN 01061083A) | |
| Enumeration Date | 2007-02-03 |
| Last Update Date | 2021-03-05 |