| NPI | 1891804092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: GA 025658) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: GA 025658) |
| 207ND0900X Dermatology, Dermatopathology (Licence: GA 025658) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: GA 025658) | |
| 208200000X Plastic Surgery (Licence: GA 025658) | |
| 208600000X Surgery (Licence: GA 025658) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: GA 025658) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2007-07-08 |