| NPI | 1104817410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: GA 038615) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: GA 038615) |
| 207Q00000X Family Medicine (Licence: GA 38615) | |
| 207N00000X Dermatology (Licence: GA 038615) | |
| 207N00000X Dermatology (Licence: SC 17623) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: GA 038615) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: SC 17623) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: GA 038615) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: SC 17623) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: SC 17623) | |
| 207R00000X Internal Medicine (Licence: GA 038615) | |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2021-03-31 |