| NPI | 1366683948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A110302) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA A110302) |
| Enumeration Date | 2009-03-11 |
| Last Update Date | 2013-08-13 |