| NPI | 1518097237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IN 01063413A) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 35.134236) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: OH 35.134236) | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2021-09-16 |