| NPI | 1891779179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 49138020) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 4301115179) |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: MI 4301115179) | |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: WI 49138020) | |
| 207NS0135X Dermatology Procedural Dermatology (Licence: MI 4301115179) | |
| 207NS0135X Dermatology Procedural Dermatology (Licence: WI 49138020) | |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2021-02-23 |