| NPI | 1639149883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NE 12281) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NE 12281) |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: NE 12281) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NE 12281) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2010-01-19 |