| NPI | 1053572420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD449049) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 57.017204) |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2025-09-09 |