| NPI | 1912007956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA G58203) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: CA G058203) |
| 207ND0900X Dermatology Dermatopathology (Licence: CA G058203) | |
| 207NI0002X Dermatology Clinical & Laboratory Dermatological Immunology (Licence: CA G058203) | |
| 207NP0225X Dermatology Pediatric Dermatology (Licence: CA G058203) | |
| 207NS0135X Dermatology Procedural Dermatology (Licence: CA G058203) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2015-01-26 |