| NPI | 1477503563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA a88950) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA a88950) |
| 207Q00000X Family Medicine (Licence: CA a88950) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2007-07-08 |