| NPI | 1235197997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: DE C1-0003908) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: PA MD024957E) |
| 207ND0900X Dermatology, Dermatopathology (Licence: PA MD024957E) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: DE C1-0003908) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: PA MD024957E) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: DE C1-0003908) | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2011-01-17 |