| NPI | 1437130044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AK 129956) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 35076805) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2019-08-13 |