| NPI | 1891815247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD420353) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: PA MD420353) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: PA MD420353) | |
| 207R00000X Internal Medicine (Licence: PA MD420353) | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2014-03-05 |