| NPI | 1902865959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 30247) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: AZ 30247) |
| 207NS0135X Dermatology Procedural Dermatology (Licence: AZ 30247) | |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2012-08-09 |