| NPI | 1891765459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: FL Me45255) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME45255) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL me45255) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: FL Me45255) | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2019-07-19 |