| NPI | 1417971367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology Procedural Dermatology (Licence: OH 34005284) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 34005284F) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2023-08-21 |