| NPI | 1013912906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: MO R6H14) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: MO R6H14) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2021-03-23 |