| NPI | 1346637048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: TN 61190) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 60832) |
| 207N00000X Dermatology (Licence: AL 38079) | |
| Enumeration Date | 2015-04-20 |
| Last Update Date | 2020-10-07 |