| NPI | 1285755736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MN 52932) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IA 37208) |
| 207N00000X Dermatology (Licence: IA R-7752) | |
| 207N00000X Dermatology (Licence: MN 52932) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: IA 37208) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: IA 37208) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2020-10-05 |