| NPI | 1215975867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: KS 430545) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KS 430545) |
| 207N00000X Dermatology (Licence: MO 2004016900) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MO 2004016900) | |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2017-08-04 |