| NPI | 1023036282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: PA MD065115L) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: PA MD065115L) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2007-07-09 |