| NPI | 1073837845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KY 47190) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: KY 47190) |
| Enumeration Date | 2010-03-22 |
| Last Update Date | 2021-06-23 |