| NPI | 1972921955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 286496) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 35.134196) |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2021-06-17 |