| NPI | 1073683710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA G17033) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: CA G17033) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA G17033) | |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2014-01-13 |