| NPI | 1194926014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 4301085545) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 35093223) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2021-04-29 |