| NPI | 1104805381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MO 2002004006) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MO 2002004006) |
| Enumeration Date | 2006-01-16 |
| Last Update Date | 2009-09-24 |