| NPI | 1437117116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL OS8364) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL 088364) |
| 207ND0900X Dermatology, Dermatopathology (Licence: FL 088364) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: FL 088364) | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2020-08-18 |