| NPI | 1215095179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A65562) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA A65562) |
| 207ND0900X Dermatology, Dermatopathology (Licence: CA A65562) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CA A65562) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2007-07-08 |