| NPI | 1497272090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: KY 56932) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KY 56932) |
| Enumeration Date | 2017-08-24 |
| Last Update Date | 2024-08-13 |