| NPI | 1093763104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA G083905) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA G083905) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2010-04-14 |