| NPI | 1588822670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA 20A14908) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NV DO2294) |
| 207N00000X Dermatology (Licence: OH 34.010509) | |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2018-01-09 |