| NPI | 1639231087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WV 20946) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MD436112) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: PA MD436112) | |
| 207N00000X Dermatology (Licence: WV 20946) | |
| 207N00000X Dermatology (Licence: OH 90420) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: OH 90429) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: OH 90429) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: WV 20946) | |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2015-01-23 |