| NPI | 1184630709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: LA MD.09675R) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: LA MD.09675R) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2020-02-04 |