| NPI | 1356460018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KY 35119) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: KY 35119) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: KY K35119) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2009-12-04 |