| NPI | 1326163890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WV 1159) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 34005620) |
| 207N00000X Dermatology (Licence: PA OS006564L) | |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2007-07-08 |