| NPI | 1679651590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A95507) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A95507) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA A95507) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2019-11-19 |