| NPI | 1497751085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NC 200201027) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: NC 200201027) |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: NC 200201027) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NC 200201027) | |
| 207N00000X Dermatology (Licence: NC 200201027) | |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2015-01-05 |