| NPI | 1104870567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: ID M6826) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: ID M6826) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2018-05-22 |