| NPI | 1376536284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 3747P1801X Technician, Personal Care Attendant |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: OH 35055850P) |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2026-08-13 |