| NPI | 1114128808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MD D72126) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MD D72126) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: PA MD438908) | |
| 207N00000X Dermatology (Licence: PA MD438908) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2018-01-09 |