| NPI | 1104804632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: WV 22486) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A90075) |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: PA MD430086) | |
| 207N00000X Dermatology (Licence: WV 22486) | |
| 207NS0135X Dermatology Procedural Dermatology (Licence: WV 22486) | |
| 207N00000X Dermatology (Licence: PA MD430086) | |
| 207NS0135X Dermatology Procedural Dermatology (Licence: PA MD430086) | |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2015-01-23 |