| NPI | 1356334965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO 48132) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CO DR.0048132) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2020-09-03 |