| NPI | 1023246527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME113504) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME113504) |
| 207ND0900X Dermatology, Dermatopathology (Licence: FL ME113504) | |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2021-03-22 |