| NPI | 1689841025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: KS 04-37477) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 52239) |
| 207N00000X Dermatology (Licence: MN 104499) | |
| 207N00000X Dermatology (Licence: KS 04-37477) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MO 2022049288) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MN 52239) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: KS 04-37477) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: MN 52239) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: MN 52239) | |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2023-03-21 |