| NPI | 1518968387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 5348841-1205) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MT 10128) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MT 10128) | |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2014-11-17 |