| NPI | 1255357182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME80876) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME80876) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2020-05-20 |