| NPI | 1265895932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: IN 01085760A) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 35138872) |
| 207N00000X Dermatology (Licence: IL 125070659) | |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2021-10-08 |