| NPI | 1013335751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: CO DR.0062048) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CO DR.0062048) |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2019-08-15 |