| NPI | 1104321587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MO 2024000630) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: GA 91881) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: GA 91881) | |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2024-08-31 |