| NPI | 1275597114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: DE C1-0003715) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: DE C10003715) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: DE C1-0003715) | |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2020-08-12 |