| NPI | 1881794493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: NH 13940) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME96825) |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: FL ME96825) | |
| 207NP0225X Dermatology Pediatric Dermatology (Licence: FL ME96825) | |
| 207NS0135X Dermatology Procedural Dermatology (Licence: FL ME96825) | |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: MA 265468) | |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2016-10-07 |