| NPI | 1871882225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: GA 76962) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MO 2015008267) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: GA 76962) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: GA 76962) | |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2022-05-24 |