| NPI | 1801835509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA 24575) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: WA 24575) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WA 24575) | |
| 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: WA 24575) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2017-03-21 |