| NPI | 1508225947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL OS14108) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL UO4347) |
| 207N00000X Dermatology (Licence: FL OS14108) | |
| Enumeration Date | 2016-02-13 |
| Last Update Date | 2020-08-28 |