| NPI | 1063406965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: WI 28242) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WI 28242) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2020-10-01 |