| NPI | 1053384693 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 74649) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MA 74649) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2007-07-08 |