| NPI | 1942302799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME133377) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CO 23922) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2018-03-17 |