| NPI | 1144510298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: PA MD463903) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AZ 52697) |
| 174400000X Specialist (Licence: AZ 52697) | |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2021-11-22 |