| NPI | 1417120601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: GA 064830) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WV 25907) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: VA 010101256173) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: GA GA64830) | |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2019-02-07 |