| NPI | 1144297847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 35-049740C) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 35-049740) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: OH 35-049740C) | |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2015-08-14 |