| NPI | 1417168535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 242646) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MA 242646) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2015-09-24 |