| NPI | 1639337181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA A120997) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A120997) |
| 207N00000X Dermatology (Licence: TN 61314) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TN 61314) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: TN 61314) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CA A120997) | |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2023-04-14 |