| NPI | 1164479960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NC 2007-00217) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: IL 036-115339) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2013-06-27 |