| NPI | 1427139674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MI 4301069806) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: GU M1527) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: IN 01074279A) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2021-07-08 |