| NPI | 1770563728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology Procedural Dermatology (Licence: PA MD031644E) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: PA MD031644E) |
| 207ND0900X Dermatology Dermatopathology (Licence: PA MD031644E) | |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2017-09-01 |