| NPI | 1982685475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: RI MD09788) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 209859) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2025-12-17 |