| NPI | 1437141900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: CO 40528) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CO 40528) |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2013-05-07 |