| NPI | 1740438423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 35121262) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MO 2009009411) |
| Enumeration Date | 2008-09-05 |
| Last Update Date | 2014-01-15 |