| NPI | 1154565661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NC 2019-01570) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 4301106561) |
| 207N00000X Dermatology (Licence: HI MD17679) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: HI MD17679) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME142263) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MI 4301106561) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AZ 49483) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CA A125540) | |
| Enumeration Date | 2009-04-28 |
| Last Update Date | 2024-01-02 |