| NPI | 1093784159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MA 220355) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NH 21929) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NH 21929) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2023-06-23 |