| NPI | 1003133901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: KY 46671) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: OH 35.122932) |
| Enumeration Date | 2010-05-01 |
| Last Update Date | 2021-08-31 |