| NPI | 1346281250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MN 26385) |
| Additional Taxonomies | 174400000X Specialist (Licence: MN 26385) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2022-08-22 |