| NPI | 1609990605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL 0076069) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL 0076069) |
| 207ND0900X Dermatology, Dermatopathology (Licence: FL 0076069) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: FL 0076069) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: FL 0076069) | |
| Enumeration Date | 2007-03-17 |
| Last Update Date | 2008-05-15 |