| NPI | 1801814272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC BP1337206) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 35058429P) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2025-09-15 |