| NPI | 1528180015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD00048856) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WA MD00048856) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2019-04-29 |