| NPI | 1023272309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA A111137) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: CA A111137) |
| 207N00000X Dermatology (Licence: CA A111137) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: CA A111137) | |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2021-11-03 |