| NPI | 1912074048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 032018) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 4301048086) |
| 207N00000X Dermatology (Licence: IN 01022758A) | |
| 207N00000X Dermatology (Licence: CA C35940) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2010-05-24 |