| NPI | 1316904147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: GA 052722) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: GA D52722) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2019-07-11 |