| NPI | 1609087121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 35.137019) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0101252291) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2020-12-30 |