| NPI | 1447545603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: NC 2022-01519) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 2022-01519) |
| 207NS0135X Dermatology Procedural Dermatology (Licence: NC 2022-01519) | |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2023-07-07 |