| NPI | 1386603009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology Procedural Dermatology (Licence: FL ME 68919) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: FL ME 68919) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2015-04-16 |