| NPI | 1215989587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NS0135X Dermatology Procedural Dermatology (Licence: SC 27131) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: SC 27131) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2021-04-22 |