| NPI | 1326074774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: CO 27691) |
| Additional Taxonomies | 207ND0900X Dermatology Dermatopathology (Licence: CO 27691) |
| 207NS0135X Dermatology Procedural Dermatology (Licence: CO 27691) | |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2023-08-29 |