| NPI | 1760448302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA 20A7954) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: CA 20A7954) |
| 207NP0225X Dermatology Pediatric Dermatology (Licence: CA 20A7954) | |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: CA 20A7954) | |
| Enumeration Date | 2006-04-22 |
| Last Update Date | 2007-08-20 |