| NPI | 1487620167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: KS 0429936) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KS 0429936) |
| 207ND0900X Dermatology, Dermatopathology (Licence: KS 0429936) | |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2020-09-28 |