| NPI | 1831385897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: GA 056975) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: DC MD036880) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: GA 056975) | |
| 207ZD0900X Pathology, Dermatopathology (Licence: GA 056975) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: GA 056975) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: GA 056975) | |
| 208D00000X General Practice (Licence: GA 056975) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: GA 056975) | |
| Enumeration Date | 2007-09-23 |
| Last Update Date | 2015-04-22 |