| NPI | 1952304560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 35.025085) |
| Additional Taxonomies | 207NP0225X Dermatology, Pediatric Dermatology (Licence: OH 35.025085) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2020-10-31 |