| NPI | 1730165002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 35.133947) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KY 48432) |
| 207N00000X Dermatology (Licence: NC 33040) | |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2018-07-24 |