| NPI | 1912161522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 35-099234) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 4301094022) |
| 207R00000X Internal Medicine (Licence: IL 125054705) | |
| Enumeration Date | 2008-07-12 |
| Last Update Date | 2020-12-17 |