| NPI | 1548251127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: MA 218812) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 218812) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2021-12-13 |