| NPI | 1285734822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 364336-1205) |
| Additional Taxonomies | 207ND0900X Dermatology Dermatopathology (Licence: NC 2007-00601) |
| 207NS0135X Dermatology Procedural Dermatology (Licence: NC 2007-00601) | |
| 207N00000X Dermatology (Licence: NC 2007-00601) | |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: NC 2007-00601) | |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2011-06-09 |