| NPI | 1164633467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 35122088) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: DC FK1416812) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: OH 35122088) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: OH 35122088) | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2017-06-08 |