| NPI | 1467816462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NC 217682) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 217682) |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2021-07-02 |