| NPI | 1407029762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WA MD 60075013) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: RI MD12612) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: RI MD12612) | |
| 207N00000X Dermatology (Licence: WA MD 60075013) | |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2013-10-22 |