| NPI | 1396770665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101031834) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: PA MD464996) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: VA 0101031834) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2021-03-23 |