| NPI | 1053387050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME103242) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: VA 101044482) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WA md60147325) | |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2014-03-18 |