| NPI | 1831514025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 34.013501) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 5101021720) |
| Enumeration Date | 2014-02-24 |
| Last Update Date | 2024-03-27 |