| NPI | 1811480254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 35.144951) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IA R-11450) |
| 207N00000X Dermatology (Licence: IL 125071930) | |
| 207R00000X Internal Medicine (Licence: IL 125071930) | |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2022-07-15 |