| NPI | 1265895619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA A171167) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A171167) |
| 207N00000X Dermatology (Licence: SC LL41017) | |
| Enumeration Date | 2016-04-02 |
| Last Update Date | 2021-06-08 |