| NPI | 1548536972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WA MD60604630) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA a127623) |
| 207N00000X Dermatology (Licence: WA 60604630) | |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2021-01-29 |