| NPI | 1992086102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KY 51117) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 35.134519) |
| Enumeration Date | 2011-08-31 |
| Last Update Date | 2024-09-05 |