| NPI | 1972786952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 35.135384) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WV 23119) |
| Enumeration Date | 2007-12-12 |
| Last Update Date | 2022-02-09 |