| NPI | 1215930722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: PA MD041957E) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MD041957E) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2015-02-26 |