| NPI | 1093744096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NC 00844) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 200600844) |
| 207N00000X Dermatology (Licence: NC 00844) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NC 00844) | |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2017-05-08 |