| NPI | 1497758866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: AZ 41528) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AZ 41528) |
| 207N00000X Dermatology (Licence: KY 25734) | |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: KY 25734) | |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2016-08-26 |