| NPI | 1033246814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: WV 13638) |
| Additional Taxonomies | 207ND0900X Dermatology Dermatopathology (Licence: PA MD043359L) |
| 207NS0135X Dermatology Procedural Dermatology (Licence: WV 13638) | |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2007-07-08 |