| NPI | 1306586003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 35.156069) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 4301517856) |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2026-07-29 |