| NPI | 1437474772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: LA MD.204848) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AL 32941) |
| 207P00000X Emergency Medicine (Licence: LA 204848) | |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2020-02-26 |