| NPI | 1396970539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NC 2013-02484) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NY 258454-1) |
| 207N00000X Dermatology (Licence: AL 32218) | |
| Enumeration Date | 2009-05-18 |
| Last Update Date | 2014-09-19 |