| NPI | 1548671928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: TN 59533) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TN 59533) |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: AL 36849) | |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2020-10-05 |