| NPI | 1134196686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 37135) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NH 15753) |
| 174400000X Specialist (Licence: MA 37135) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MA 37135) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NH 15753) | |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2024-07-19 |