| NPI | 1316174956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A150539) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MO 2009016609) |
| 207N00000X Dermatology (Licence: OH 35.122221) | |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2024-03-08 |