| NPI | 1366432312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA G40700) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G40700) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA G40700) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CA G40700) | |
| 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: CA G40700) | |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2016-04-07 |