| NPI | 1134547656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO 2019029136) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 35.133142) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MO 2019029136) | |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2023-08-16 |