| NPI | 1720059736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MD D0043824) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: VA 0101232840) |
| 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: VA 0101232840) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: VA 0101232840) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: VA 0101232840) | |
| Enumeration Date | 2006-01-28 |
| Last Update Date | 2023-01-25 |