| NPI | 1720378169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MS 29717) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TN 56136) |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: MS 29717) | |
| 207ND0900X Dermatology Dermatopathology (Licence: MS 29717) | |
| 207ND0900X Dermatology Dermatopathology (Licence: NY 261924) | |
| 207ND0900X Dermatology Dermatopathology (Licence: FL ME116247) | |
| 207ND0900X Dermatology Dermatopathology (Licence: TN 56136) | |
| 207ND0900X Dermatology Dermatopathology (Licence: AL MD.32613) | |
| 207NS0135X Dermatology Procedural Dermatology (Licence: MS 29717) | |
| Enumeration Date | 2011-04-18 |
| Last Update Date | 2023-05-07 |