| NPI | 1275685000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: SC 16908) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: SC 16908) |
| 207ND0900X Dermatology Dermatopathology (Licence: SC 16908) | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2020-10-06 |