| NPI | 1730189747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WV 1500) |
| Additional Taxonomies | 207NP0225X Dermatology, Pediatric Dermatology (Licence: WV 1500) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: WV 1500) | |
| 207N00000X Dermatology (Licence: MD H82265) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WV 1500) | |
| Enumeration Date | 2005-08-01 |
| Last Update Date | 2017-02-20 |