| NPI | 1316056567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 34003451) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AZ 1889) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2013-12-20 |