| NPI | 1417334343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL Os13427) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL OS13427) |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2020-08-09 |