| NPI | 1982711925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME141554) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 120151-1) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2022-04-22 |