| NPI | 1831239094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: CO 48187) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: KY 41638) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME94256) | |
| 207N00000X Dermatology (Licence: KY 41638) | |
| 207N00000X Dermatology (Licence: FL ME94256) | |
| 207N00000X Dermatology (Licence: CO 48187) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CO 48187) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2022-03-31 |