| NPI | 1255365334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MI 5601039679) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 4301039679) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2022-02-22 |