| NPI | 1174624019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: HI MD-5585) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: HI MD-5585) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2020-09-25 |