| NPI | 1326040965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 1730) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: AZ 1730) |
| 207NS0135X Dermatology Procedural Dermatology (Licence: AZ 1730) | |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2011-08-02 |