| NPI | 1508061128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: CT 049530) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA L-232692) |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2023-09-21 |