| NPI | 1114450889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: NE 34491) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NE 34491) |
| Enumeration Date | 2017-04-09 |
| Last Update Date | 2022-07-18 |