| NPI | 1295965119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: AZ 006467) |
| Additional Taxonomies | 174400000X Specialist (Licence: NV SL0673) |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2019-11-07 |