| NPI | 1720136823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A73051) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: CA A73051) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CA A73051) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA A73051) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: CA A73051) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2015-08-25 |