| NPI | 1376631580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: KY 32374) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KY 32374) |
| 207ND0900X Dermatology, Dermatopathology (Licence: KY 32374) | |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2020-06-09 |