| NPI | 1578787735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KY 48776) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 256380) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NY 256380) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: KY 48776) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 256380) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: IN 01076508A) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: IN 01076508A) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: KY 48776) | |
| 207N00000X Dermatology (Licence: IN 01076508A) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2021-09-21 |