| NPI | 1598765943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MS 22119) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 35051453) |
| 207ND0900X Dermatology, Dermatopathology (Licence: OH 35051453) | |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2017-10-06 |