| NPI | 1073500278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA G77643) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA G77643) |
| 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: CA G77643) | |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2011-09-07 |