| NPI | 1215928619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CT 040087) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 211008) |
| 207N00000X Dermatology (Licence: NY 211008) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NY 211008) | |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2007-07-08 |