| NPI | 1972611556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: NV 10713) |
| Additional Taxonomies | 207ZD0900X Pathology, Dermatopathology (Licence: OK 23337) |
| 207N00000X Dermatology (Licence: OK 23337) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OK 4820) | |
| 207ZD0900X Pathology, Dermatopathology (Licence: NV 10713) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NV 10713) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NV 10713) | |
| 207N00000X Dermatology (Licence: NV 10713) | |
| 207ZP0101X Pathology, Anatomic Pathology (Licence: NV 10713) | |
| 207N00000X Dermatology (Licence: AZ 31661) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: AZ 31661) | |
| 207ZD0900X Pathology, Dermatopathology (Licence: AZ 31661) | |
| 207ZP0101X Pathology, Anatomic Pathology (Licence: AZ 31661) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AZ 31661) | |
| 208D00000X General Practice (Licence: NV 10713) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2016-07-20 |