| NPI | 1457514689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: WA MD60343797) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA MD60343797) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2020-11-03 |