| NPI | 1457466971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME1111720) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: GA 068626) |
| 207N00000X Dermatology (Licence: SC 13943) | |
| 207N00000X Dermatology (Licence: KY TP025) | |
| 207N00000X Dermatology (Licence: AL 30999) | |
| 207N00000X Dermatology (Licence: NC 200400611) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NC 200400611) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2023-03-22 |