| NPI | 1205814712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 35074869W) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CO 42777) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2007-10-19 |