| NPI | 1396163721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: LA 313274) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MO 2019024448) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MO 2019024448) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: MO 2019024448) | |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2019-12-10 |