| NPI | 1962592337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 35-092701) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME85735) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2013-04-03 |