| NPI | 1639112147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA G064878) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: CA G064878) |
| 207ND0900X Dermatology Dermatopathology (Licence: CA G064878) | |
| 207NS0135X Dermatology Procedural Dermatology (Licence: CA G064878) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2014-01-20 |