| NPI | 1215979398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME00552008) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME0052008) |
| 207N00000X Dermatology (Licence: FL ME00552008) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2023-05-09 |