| NPI | 1275571028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: CA G58478) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA G58478) |
| 207ND0900X Dermatology Dermatopathology (Licence: CA G58478) | |
| 207NS0135X Dermatology Procedural Dermatology (Licence: CA G58478) | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2020-10-12 |