| NPI | 1164458873 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MD D0040882) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: MD D0040882) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2020-10-05 |