| NPI | 1154387413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA G61252) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G61252) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CA G61252) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2020-11-02 |