| NPI | 1265994412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MN 30654) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 67970) |
| Enumeration Date | 2019-04-04 |
| Last Update Date | 2023-06-30 |