| NPI | 1134488638 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD457011) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: PA MD457011) |
| Enumeration Date | 2012-05-04 |
| Last Update Date | 2024-04-05 |