| NPI | 1497931380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA A107312) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: GA 058457) |
| 207N00000X Dermatology (Licence: CA A107312) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CA A107312) | |
| Enumeration Date | 2008-01-10 |
| Last Update Date | 2022-10-07 |