| NPI | 1124024880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NM 2000-174) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NM 2000-174) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: IA 32332) | |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2023-12-13 |