| NPI | 1225411705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MI 5101021659) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 5101021659) |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2020-09-16 |