| NPI | 1134177488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: NE 20113) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NE 20113) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2011-07-11 |