| NPI | 1083054571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 56105) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA A148673) |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: AZ 56105) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: CA A148673) | |
| 207R00000X Internal Medicine (Licence: PA MT204558) | |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2024-10-18 |