| NPI | 1952530222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: GA 070200) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME143144) |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2020-01-03 |