| NPI | 1376706101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2017-02073) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NC 201702073) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL OS12265) | |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2019-02-22 |