| NPI | 1821099615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 35-06-3717T) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: OH 35-06-3717T) |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2010-06-22 |