| NPI | 1982600011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A55764) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: CA A55764) |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: CA A55764) | |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2013-08-09 |