| NPI | 1215918321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TN MD8174) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: TN MD8174) |
| 207ND0900X Dermatology Dermatopathology (Licence: TN MD8174) | |
| 207NS0135X Dermatology Procedural Dermatology (Licence: TN MD8174) | |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2007-07-08 |