| NPI | 1700128584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 35.130388) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 298614) |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2024-07-02 |