| NPI | 1780625335 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 35.099860) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AL MD 25639) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2019-03-25 |