| NPI | 1245676774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: SC 51796) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: SC 51796) |
| 207R00000X Internal Medicine (Licence: NC 191622) | |
| Enumeration Date | 2013-05-10 |
| Last Update Date | 2020-10-13 |