| NPI | 1003891052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 35091436) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AZ 33473) |
| 207ZD0900X Pathology, Dermatopathology (Licence: OH 35091436) | |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2017-06-08 |