| NPI | 1134562861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: GA 82820) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: GA 82820) |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2021-02-12 |