| NPI | 1053420117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME30624) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME30624) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2010-03-09 |