| NPI | 1366583882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AL DO967) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MO 2007022070) |
| 207R00000X Internal Medicine (Licence: FL OS9692) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: IA 4181) | |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2023-03-13 |