| NPI | 1710047097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME0046734) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME0046734) |
| 207ND0900X Dermatology, Dermatopathology (Licence: FL ME0046734) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: FL ME0046734) | |
| Enumeration Date | 2006-12-09 |
| Last Update Date | 2012-03-19 |