| NPI | 1215910336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NC 200400240) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: NC 200400240) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2012-09-25 |