| NPI | 1447428321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WI 57581) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WI 57581) |
| 207N00000X Dermatology (Licence: MN 51083) | |
| 207N00000X Dermatology (Licence: MN 103829) | |
| 207R00000X Internal Medicine (Licence: CO 2578) | |
| Enumeration Date | 2008-02-13 |
| Last Update Date | 2020-10-06 |