| NPI | 1477755916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IL 036.145788) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 57.010880) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2018-07-26 |