| NPI | 1265422497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 4301077180) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: MI GM077180) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MI GM077180) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: MI GM077180) | |
| 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: MI GM077180) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: MI GM077180) | |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2021-03-31 |