| NPI | 1073937835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA A162943) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A162943) |
| 208D00000X General Practice (Licence: NE 28714) | |
| Enumeration Date | 2014-02-13 |
| Last Update Date | 2024-03-14 |