| NPI | 1053426015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NH 9566) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 71769) |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: MA 71769) | |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: NH 9566) | |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2011-12-13 |