| NPI | 1043212350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CT 47442) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: GA 044059) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: GA 044059) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: GA 044059) | |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2016-08-15 |