| NPI | 1558355859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology Procedural Dermatology (Licence: IA 34780) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IA 34780) |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: IA 34780) | |
| Enumeration Date | 2005-09-01 |
| Last Update Date | 2007-11-27 |