| NPI | 1164621579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 35097316) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: OH 35097316) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: OH 35097316) | |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2018-10-05 |