| NPI | 1881697787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR MD11786) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: OR MD11786) |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: OR MD11786) | |
| 207ND0900X Dermatology Dermatopathology (Licence: OR MD11786) | |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2007-12-03 |