| NPI | 1952300550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: OH 35050179) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: OH 35-05-0179) |
| 207N00000X Dermatology (Licence: OH 35050179) | |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2012-03-28 |