| NPI | 1194762898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WA MD00045767) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA MD00045767) |
| 207ND0900X Dermatology, Dermatopathology (Licence: WA MD00045767) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: WA MD00045767) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2024-02-27 |