| NPI | 1063603553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: RI MD13344) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MA 246717) |
| 207N00000X Dermatology (Licence: RI MD13344) | |
| 207N00000X Dermatology (Licence: MA 246717) | |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2020-10-14 |