| NPI | 1336126424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MN 28319) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AZ 16827) |
| 207N00000X Dermatology (Licence: FL ME50090) | |
| 207N00000X Dermatology (Licence: MN 28319) | |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2020-10-05 |