| NPI | 1386841724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME113035) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME113035) |
| 207N00000X Dermatology (Licence: CA A116805) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA A116805) | |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2021-04-21 |