| NPI | 1265439335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 27370) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AZ 27370) |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: AZ 27370) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: AZ 27370) | |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2018-10-12 |