| NPI | 1780758003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology Dermatopathology (Licence: OH 35083746) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 35083746) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2014-01-17 |