| NPI | 1508846817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MD D67264) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 057505) |
| 207N00000X Dermatology (Licence: GA 057505) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: VA 0101054810) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: GA 057505) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MD D0067264) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: GA 057505) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: GA 057505) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: GA 057505) | |
| 207ZD0900X Pathology, Dermatopathology (Licence: GA 057505) | |
| 208D00000X General Practice (Licence: GA 057505) | |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2018-06-21 |