| NPI | 1841811148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 180782) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME96641) |
| 207N00000X Dermatology (Licence: NM MD2005-0764) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME96641) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NY 180782) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NM MD2005-0764) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: FL ME96641) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NM MD2005-0764) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 180782) | |
| Enumeration Date | 2020-04-28 |
| Last Update Date | 2024-03-29 |