| NPI | 1053534172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 34.009281) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 5101016570) |
| 207NS0135X Dermatology Procedural Dermatology (Licence: OH 34.009281) | |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2015-03-04 |