| NPI | 1871551747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NV 3757) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: NV 3757) |
| 207ND0900X Dermatology Dermatopathology (Licence: NV 3757) | |
| 207NS0135X Dermatology Procedural Dermatology (Licence: NV 3757) | |
| 207R00000X Internal Medicine (Licence: NV 3757) | |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2007-07-08 |