| NPI | 1346247228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA G38870) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: CA G38870) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA G38870) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2011-09-15 |