| NPI | 1730100892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NH 23933) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OK 5176) |
| 207N00000X Dermatology (Licence: CA 20A10789) | |
| 207N00000X Dermatology (Licence: NY 235559) | |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: FL OS14334) | |
| 207Q00000X Family Medicine (Licence: OK 5176) | |
| 207Q00000X Family Medicine (Licence: CA 20A10789) | |
| 207Q00000X Family Medicine (Licence: NY 235559-1) | |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2023-06-29 |