| NPI | 1528476322 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR MD197958) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: OR MD197958) |
| Enumeration Date | 2014-07-24 |
| Last Update Date | 2024-12-07 |