| NPI | 1962405332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 35042672) |
| Additional Taxonomies | 174400000X Specialist (Licence: OH 35042675) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2011-05-20 |