| NPI | 1508833930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NV 6905) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA G59991) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NV 6905) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA G59991) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: NV 6905) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: CA G55591) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NV 6905) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CA G59991) | |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2013-02-01 |