| NPI | 1043219405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: FL ME0064734) |
| Additional Taxonomies | 207YX0905X Otolaryngology Otolaryngology/Facial Plastic Surgery (Licence: FL ME0064734) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2007-07-08 |