| NPI | 1104929553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KS 0414492) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: KS 0414492) |
| 207ND0900X Dermatology, Dermatopathology (Licence: KS 0414492) | |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2009-11-19 |