| NPI | 1508423849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 35.153371) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KY 60514) |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2025-08-07 |