| NPI | 1912900200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AZ 52539) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AZ 52539) |
| 207N00000X Dermatology (Licence: KY 34879) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: KY 34879) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: AZ 52539) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: KY 34879) | |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2020-09-30 |