| NPI | 1518958289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MA 205347) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: MA 205347) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2015-01-30 |