| NPI | 1255356119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME 72007) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: FL me72007) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL me72007) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: FL me72007) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2013-10-28 |