| NPI | 1235549205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KY 53911) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 35-134208) |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2021-02-05 |