| NPI | 1356703540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A168336) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 57.027664) |
| 207R00000X Internal Medicine (Licence: OH 57.027664) | |
| Enumeration Date | 2016-03-25 |
| Last Update Date | 2020-12-15 |