| NPI | 1548321227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 35058104) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NE 12782) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2007-10-09 |