| NPI | 1316218704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: OH 35.128425) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: NH 23711) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NH 23711) | |
| Enumeration Date | 2012-01-18 |
| Last Update Date | 2024-01-31 |