| NPI | 1053379826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: OR MD23536) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MO 2015039802) |
| 207N00000X Dermatology (Licence: OR MD23536) | |
| 207NS0135X Dermatology Procedural Dermatology (Licence: MO 2015039802) | |
| 207ND0900X Dermatology Dermatopathology (Licence: OR MD23536) | |
| 207NP0225X Dermatology Pediatric Dermatology (Licence: MO 2015039802) | |
| 207NP0225X Dermatology Pediatric Dermatology (Licence: OR MD23536) | |
| 207NS0135X Dermatology Procedural Dermatology (Licence: OR MD23536) | |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: MO 2015039802) | |
| 207ND0900X Dermatology Dermatopathology (Licence: MO 2015039802) | |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2018-03-17 |