| NPI | 1154368165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: MI 4301052816) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: MI 4301052816) |
| 207N00000X Dermatology (Licence: MI 4301052816) | |
| 207ND0900X Dermatology Dermatopathology (Licence: MI 4301052816) | |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2014-09-17 |