| NPI | 1275702656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: TX N7906) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AR E-6068) |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: AR E-6068) | |
| 207NS0135X Dermatology Procedural Dermatology (Licence: AR E-6068) | |
| 207NS0135X Dermatology Procedural Dermatology (Licence: TX N7906) | |
| 207N00000X Dermatology (Licence: TX N7906) | |
| Enumeration Date | 2008-02-29 |
| Last Update Date | 2011-09-27 |