| NPI | 1497970560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: WI 53110-020) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WI 53110-20) |
| 207N00000X Dermatology (Licence: MN 51745) | |
| 207N00000X Dermatology (Licence: RI LP00514) | |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2023-03-07 |