| NPI | 1396848289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 4301064937) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: MI 4301064937) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MI 4301064937) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MI 4301064937) | |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2008-06-02 |