| NPI | 1316175128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: GA 73661) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: SC 32031) |
| 207N00000X Dermatology (Licence: GA 73661) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CA A124812) | |
| 207N00000X Dermatology (Licence: FL ME120226) | |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2021-06-07 |