| NPI | 1235102922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NH 8614) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NH 8614) |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: NH 8614) | |
| 207NS0135X Dermatology Procedural Dermatology (Licence: NH 8614) | |
| Enumeration Date | 2006-02-11 |
| Last Update Date | 2019-10-14 |