| NPI | 1417941964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: GA 038069) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: GA 038609) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: GA 038609) | |
| 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: GA 038609) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: GA 038609) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: GA 038069) | |
| 208D00000X General Practice (Licence: GA 038069) | |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2015-04-23 |