| NPI | 1952565897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 35121523) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 4301092937) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2018-03-19 |