| NPI | 1174704183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0102203385) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 34.009401) |
| 207R00000X Internal Medicine (Licence: OH 58-002558) | |
| Enumeration Date | 2007-11-19 |
| Last Update Date | 2021-01-11 |