| NPI | 1346380896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MD D61859) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: MD D61859) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2017-02-06 |