| NPI | 1245543495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 100512) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MO 2010019769) |
| 207N00000X Dermatology (Licence: OK 5332) | |
| 207N00000X Dermatology (Licence: OH 34.012777) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: OH 34.012777) | |
| Enumeration Date | 2010-07-16 |
| Last Update Date | 2023-06-08 |