| NPI | 1235660952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: SC 87684) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MT215377) |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2022-10-28 |