| NPI | 1295776201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: CO 53082) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CO 53082) |
| 207N00000X Dermatology (Licence: HI 6814) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2020-11-05 |