| NPI | 1508858044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: FL 0032383) |
| Additional Taxonomies | 207ND0900X Dermatology Dermatopathology (Licence: FL ME0032383) |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2020-01-15 |