| NPI | 1285812446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 247102) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: MA 247102) |
| 207ND0900X Dermatology, Dermatopathology (Licence: OH 35 123477) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: KY 47322) | |
| Enumeration Date | 2008-02-09 |
| Last Update Date | 2018-08-21 |