| NPI | 1013170695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 49416) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AZ 49416) |
| 207ND0900X Dermatology, Dermatopathology (Licence: AZ 49416) | |
| 207N00000X Dermatology (Licence: PA MD450182) | |
| 207N00000X Dermatology (Licence: CO 50202) | |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2021-12-22 |