| NPI | 1255320115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AL 10357) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CO DR.0074440) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2024-12-04 |