| NPI | 1326469743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: CA 20A19597) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: OR DO209078) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA 20A19597) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: OR DO209078) | |
| 207N00000X Dermatology (Licence: OR DO209078) | |
| 207N00000X Dermatology (Licence: VA 0102204286) | |
| 207N00000X Dermatology (Licence: CA 20A19597) | |
| Enumeration Date | 2014-01-02 |
| Last Update Date | 2024-03-21 |