| NPI | 1922092071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MN 52922) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: AZ 52558) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: WI 60010) | |
| 207N00000X Dermatology (Licence: IA 28611) | |
| 207N00000X Dermatology (Licence: AZ 52558) | |
| 207N00000X Dermatology (Licence: WI 60010) | |
| 207N00000X Dermatology (Licence: MN 52922) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: IA 28611) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AZ 52558) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WI 60010) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: IA 28611) | |
| Enumeration Date | 2005-09-06 |
| Last Update Date | 2021-01-28 |