| NPI | 1275523110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MD D0063751) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 35-086442) |
| Enumeration Date | 2005-10-23 |
| Last Update Date | 2014-03-12 |