| NPI | 1972708329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME113493) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 57.012600) |
| 207N00000X Dermatology (Licence: GA 66023) | |
| 207N00000X Dermatology (Licence: KY IP1035) | |
| Enumeration Date | 2007-06-17 |
| Last Update Date | 2024-05-20 |