| NPI | 1063668531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AZ 45164) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A103734) |
| Enumeration Date | 2008-08-15 |
| Last Update Date | 2019-11-07 |