| NPI | 1265961304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MD D0091254) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 57.245363) |
| 207R00000X Internal Medicine (Licence: IL 125.070973) | |
| Enumeration Date | 2017-06-11 |
| Last Update Date | 2021-06-25 |