| NPI | 1063855286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: MI 4301502950) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 4301502950) |
| 207N00000X Dermatology (Licence: OH 35.140316) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: MI 4301502950) | |
| Enumeration Date | 2013-04-08 |
| Last Update Date | 2026-05-14 |