| NPI | 1417342890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: VA 0101275415) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: ME MD23389) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MD D91604) | |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2023-11-29 |