| NPI | 1922460500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 35.141305) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: OH 35.141305) |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2022-12-19 |