| NPI | 1922391150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: RI MD15053) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME127406) |
| Enumeration Date | 2011-05-20 |
| Last Update Date | 2019-05-23 |