| NPI | 1104814045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: OK 4552) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OK 4552) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2022-01-28 |