| NPI | 1538115548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: FL ME32634) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: MI 4301035259) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME32634) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: SC 6783) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2020-10-05 |