NPI | 1285675538 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: CA 20A4092) |
Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: CA 20A4092) |
207ND0900X Dermatology Dermatopathology (Licence: CA 20A4092) | |
207NP0225X Dermatology Pediatric Dermatology (Licence: CA 20A4092) | |
207NS0135X Dermatology Procedural Dermatology (Licence: CA 20A4092) | |
Enumeration Date | 2006-06-09 |
Last Update Date | 2012-10-15 |