| NPI | 1366565467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA G89274) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA G89274) |
| 207ND0900X Dermatology, Dermatopathology (Licence: CA G89274) | |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2020-02-11 |