| NPI | 1558338376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: TN MD11469) |
| Additional Taxonomies | 207ND0900X Dermatology Dermatopathology (Licence: TN MD11469) |
| 207NS0135X Dermatology Procedural Dermatology (Licence: TN MD11469) | |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2007-07-08 |