| NPI | 1326154253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 237528) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0101242445) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: VA 0101242445) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: VA 0101242445) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: VA 0101242445) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NY 237528) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 237528) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: NY 237528) | |
| 207N00000X Dermatology (Licence: WV 27320) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: WV 27320) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WV 27320) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: WV 27320) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2017-05-01 |