| NPI | 1659381754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 35.045960) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MD451399) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2021-02-17 |