| NPI | 1316969694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: RI MD13562) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WV 25087) |
| 207N00000X Dermatology (Licence: RI MD13562) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2021-11-04 |