| NPI | 1275526915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 35-058847) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: OH 35-058847) |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2017-06-08 |