| NPI | 1952387664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: OH 35045754) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 35.045754) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2015-06-26 |