| NPI | 1689656720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: GA 052707) |
| Additional Taxonomies | 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: GA 052707) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: GA 052707) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: GA 052707) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: GA 052707) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: GA 052707) | |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2008-02-13 |