| NPI | 1003226051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2019-00501) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0101266560) |
| 207N00000X Dermatology (Licence: FL ME124757) | |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: NC 2019-00501) | |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: VA 0101266560) | |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2019-07-09 |