| NPI | 1477650901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A22970) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: CA A22970) |
| 207NI0002X Dermatology Clinical & Laboratory Dermatological Immunology (Licence: CA A22970) | |
| 207NP0225X Dermatology Pediatric Dermatology (Licence: CA A22970) | |
| 207NS0135X Dermatology Procedural Dermatology (Licence: CA A22970) | |
| 207ZD0900X Pathology Dermatopathology (Licence: CA A22970) | |
| Enumeration Date | 2006-09-19 |
| Last Update Date | 2023-10-24 |